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November 17, 2025 Jennifer Polzin, Authorized Agent Tubman Safe Journeys Youth Program 4432 Chicago Avenue Minneapolis, MN 55407 License Number: 1081271 CORRECTION ORDER Dear Ms. Polzin: On September 29 and 30, 2025, Department of Human Services (DHS) licensors conducted a licensing review at your facility, Tubman Safe Journeys Youth Program located at 1725 Monastery Way, Maplewood, MN 55109. This review was conducted to determine compliance with state and federal laws and rules governing the provision of children’s residential facilities under Minnesota Rules, parts 2960.0010 through 2960.0120, and under transitional services Minnesota Rules, 2960.0500, (Rule CRF). As a result, DHS is issuing this order which requires you to take the correction action as described under each violation. Details of our findings are provided below. Our next steps and your options are also detailed. LICENSING VIOLATIONS DHS determined that your program did not follow licensing rules and statutes, as described below. Policies, Procedures, and Practices 1. Violation: The statement of intended use does not reference medically fragile conditions in the description of the target population. [Rule/Statute] Violated: Minnesota Rule 2960.0040, item B Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the statement of intended use meets all applicable guidelines. Within 30 days of receipt of this order, submit a statement of intended use that demonstrates compliance. 2. Violation: The Program Abuse Prevention Plan population assessment does not address mental functioning or the physical & emotional health or behavior of clients. [Rule/Statute] Violated: Minnesota Statutes, section 245A.65, subdivision 2a Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the Program Abuse Prevention Plan meets all applicable guidelines. Within 30 days of receipt of this order, submit a Program Abuse Prevention Plan that demonstrates compliance. 3. Violation: The Vulnerable Adult Maltreatment Reporting policy does not specify the reporter will be notified in writing whether the facility has reported the incident to the common entry point. [Rule/Statute] Violated: Minnesota Statutes, section 626.557, subdivision 4a, paragraph (b) Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the Vulnerable Adult Maltreatment Reporting policy meets all applicable guidelines. Within 30 days of receipt of this order, submit a Vulnerable Adult Maltreatment Reporting policy that demonstrates compliance. 4. Violation: The Maltreatment of Minors Reporting policy does not state the license holder will ensure that an internal review is completed within 30 calendar days. [Rule/Statute] Violated: Minnesota Statutes, section 245A.66 Corrective Action Required: Immediately and on an ongoing basis, the license holder must ensure the Maltreatment of Minors Reporting policy meets all applicable guidelines. Within 30 days of receipt of this order, submit a Maltreatment of Minors Reporting policy that demonstrates compliance. Written Response Required If you fail to correct the violation(s) specified in the Correction Order within the prescribed time lines the Commissioner may issue an Order of Conditional License or may impose a fine and order other licensing sanctions pursuant to Minnesota Statutes, sections 245A.06 and 245A.07. Submissions required as part of the corrective action ordered must be sent to your licensor by email at alyssa.nelson@state.mn us, or by mail: Commissioner, Department of Human Services ATTN: Alyssa Nelson Licensing Division PO Box 64242 St. Paul, MN 55164-0242 YOUR RIGHT TO REQUEST RECONSIDERATION You have the right to request reconsideration of this order and the cited violations. Your request must: · Be in writing · List each violation you are challenging and identify what is inaccurate or incomplete about the information in the order · Supply information that is accurate or more complete · Be made before the deadlines provided below If you are mailing your request, it must be received by DHS within 20 calendar days from when you received this order. If you do not meet this deadline, you lose your right to request reconsideration. The timeline to appeal began when you received this order. Please send it to: Office of Inspector General Legal Counsel’s Office Attn: Licensing Legal Unit PO Box 64953 St. Paul, MN 55164-0953 If your request is being personally delivered, it must be received by DHS within 20 calendar days from when you received this order. Please bring it to: Commissioner, Department of Human Services Office of Inspector General, Legal Counsel’s Office - Licensing 444 Lafayette Road North St. Paul, MN 55155 Legal authority This action is taken under Minnesota Statutes, section 245A.06, subdivision 1. The timeline to request reconsideration of the order is provided in Minnesota Statutes, section 245A.06, subdivision 2. Questions If you have any further questions regarding this matter, you may contact me at 651-431-2410 or at alyssa.nelson@state.mn.us. Sincerely, Alyssa Nelson, Licensor Licensing Division Office of Inspector General
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